Emdeon Commercial Home Health (HH), 837I 4010A1 Electronic
This format is available for any insurance defined as commercial and using a UB-04. All formatting is done using print variations.
For those commercial claims being sent through Emdeon, all claims will report the detail service lines as follows:
|
>
|
Detail Line Reporting, No Summary.
|
|
>
|
Group details (visits and supplies) by Item Date, Revenue Code, HCPCS/CPT, and Description.
|
|
>
|
Sort details by Item Date, Revenue Code, HCPCS/CPT, and Description.
|
The following fields in the application are required for Emdeon Commercial Home Health (HH), 837I 4010A1 Electronic.
|
Field
|
Description
|
|
Assignment of Benefits
and
Release of Information
|
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.
|
|
Federal Tax ID
-OR-
Social Security Number
-AND-
Provider Taxonomy Code
|
If your commercial carrier requires reporting an attending physician, enter either the physician's federal tax ID or Social Security Number.
Enter the provider's taxonomy code.
In addition, the values from the State License, UPIN, and Additional Physician fields are also reported.
These fields are located in Resource>General>Roles.
Note: By default, if the Federal Tax ID field is empty for a physician, it is automatically completed with the default value of 999999999. If your agency receives a rejection from Emdeon (formerly WebMD) or any payer submitted through the clearinghouse solution for invalid federal tax ID, your agency must obtain the actual federal tax ID from the physician and enter it in the appropriate field.
|
|
Insurance Clearinghouse
|
Add Emdeon as an insurance clearinghouse in Administration>Financial>Ins Clearinghouse.
Select Emdeon in the Clearing House field in Administration>Financial>Insurance Codes>EMC for the insurance code being billed.
|
|
Medicare Assign
|
Enter A or C in Patient>General>Payers>Pay Source>HIPAA. If selected, B is converted to A, and P is converted to C.
|
|
Payer Claim Office #
|
If required by your carrier, indicate the claim office number to which the claim will be sent in the Payer Claim Office # field in Administration>Financial>Insurance Companies>Company.
|
|
Payer IDs
|
If the commercial claims are to be filed through Emdeon, associate each insurance carrier with payer IDs from the Emdeon's payer list in Administration>Financial>Ins Clearinghouse>Payer IDs.
|
|
Permitted Home Health Activity
|
Select the type of permitted Home Health activity different from Other to submit the information in the electronic file because Other is not a valid value under HIPAA.
|
|
Provider ID
|
Enter the organization's carrier-assigned provider number in the Provider ID field in Administration>Financial>Insurance Companies>Company.
|
|
Provider ID Type
|
To meet HIPAA requirements, for commercial carriers that are Blue Cross/Blue Shield, specify if the provider ID (entered in the Provider ID field) is Blue Cross or Blue Shield in the Provider ID Type field in Administration>Financial>Insurance Companies>Company.
|
|
Provider Taxonomy Code
|
Enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>General or in Administration>Financial>Insurance Companies>Company.
|
|
Receiver ID
|
Enter 133052274 in the Receiver ID field in Administration>Financial>Ins Clearinghouse.
|
|
Receiver Name
|
Enter EMDEON in the Receiver Name field in Administration>Financial>Ins Clearinghouse.
|
|
Request for paper EOB
|
To receive a paper EOB, select the Request Paper EOB check box in Administration>Financial>Insurance Codes>EMC.
|
|
Test Submission Indicator
|
Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
|
|
Emdeon Provider Site ID
|
Enter the provider site ID assigned by Emdeon identifying the specific agency office to be sent to (one site ID for a tax ID) in the Emdeon Provider Site ID field in Administration>Configuration>Business Units>Teams and Legal Entities>Legal Entities.
|
Emdeon Commercial Home Health (HH), 837I 5010A2 Electronic
This format is available for insurances using UB-04 and defined as commercial. All formatting is done using print variations.
The commercial claims sent through Emdeon report the detail service lines as follows:
|
>
|
Detail Line Reporting, No Summary.
|
|
>
|
Group details (visits and supplies) by Item Date, Revenue Code, HCPCS/CPT, and Description.
|
|
>
|
Sort details by Item Date, Revenue Code, HCPCS/CPT, and Description.
|
For Emdeon Commercial Home Health (HH), 837I 5010A2 Electronic, define the following items:
|
>
|
In Administration>Financial>Insurance Codes>Print Variations, select the check box under FL 14-15 to ensure the ANSI 5010 Billing Template compliance.
|
Note: If values other than 3 or 1 are required, enter them in Patient>General>Claim Constants or Administration>Financial>Claim Constants.
|
>
|
Ensure that either I or Y is selected for ANSI 5010 in the Rel Infor(Release of Information) field in Patient>General>Payers>HIPAA.
|
If you need to report the external cause of injury diagnoses, enter them using claim constants at the appropriate level for FL 72A–C External Cause of Injury Code.
Payers who require the admission date to be the same as the first date of service on the claim
Select the Print first service date instead of Admit Date print variation from the Locator 12 category in Administration > Financial > Insurance Codes > Print Variations to print the initial service date instead of the admission date in FL 12 on the UB-04 form.
The following fields in the application are required for Emdeon Commercial Home Health (HH), 837I 5010A2 Electronic.
|
Field
|
Description
|
|
Assignment of Benefits
and
Release of Information
|
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.
|
|
Federal Tax ID
-OR-
Social Security Number
-AND-
Provider Taxonomy Code
-AND-
NPI
|
If your commercial carrier requires reporting an attending physician, enter either the physician's federal tax ID or Social Security Number.
Enter the provider's taxonomy code.
Enter the physician's NPI.
In addition, the values from the State License, UPIN, and Additional Physician fields are also reported.
These fields are located in Resource>General>Roles.
Note: By default, if the Federal Tax ID field is empty for a physician, it is automatically completed with the default value of 999999999. If your agency receives a rejection from Emdeon (formerly WebMD) or any payer submitted through the clearing house solution for invalid federal tax ID, your agency must obtain the actual federal tax ID from the physician and enter it in the appropriate field.
|
|
Insurance Clearinghouse
|
Add Emdeon as an insurance clearinghouse in Administration>Financial>Ins Clearinghouse.
Select Emdeon in the Clearing House field in Administration>Financial>Insurance Codes>EMC for the insurance code being billed.
|
|
Medicare Assign
|
Enter A or C in Patient>General>Payers>Pay Source>HIPAA. If selected, B is converted to A, and P is converted to C.
|
|
Payer Claim Office #
|
If required by your carrier, indicate the claim office number to which the claim will be sent in the Payer Claim Office # field in Administration>Financial>Insurance Companies>Company.
|
|
Payer IDs
|
If the commercial claims are to be filed through Emdeon, associate each insurance carrier with payer IDs from the Emdeon's payer list in Administration>Financial>Ins Clearinghouse>Payer IDs.
|
|
Permitted Home Health Activity
|
Select the type of the permitted Home Health activity different from Other to submit the information in the electronic file because Other is not a valid value under HIPAA.
|
|
Provider ID
|
Enter the organization's carrier-assigned provider number in the Provider ID field in Administration>Financial>Insurance Companies>Company.
|
|
Provider ID Type
|
To meet HIPAA requirements, for commercial carriers that are Blue Cross/Blue Shield, specify if the provider ID (entered in the Provider ID field) is Blue Cross or Blue Shield in the Provider ID Type field in Administration>Financial>Insurance Companies>Company.
|
|
Provider Taxonomy Code
|
Enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>General or in Administration>Financial>Insurance Companies>Company.
|
|
Receiver ID
|
Enter 133052274 in the Receiver ID field in Administration>Financial>Ins Clearinghouse.
|
|
Receiver Name
|
Enter EMDEON in the Receiver Name field in Administration>Financial>Ins Clearinghouse.
|
|
Request Paper EOB
|
To receive a paper EOB, select the Request Paper EOB check box in Administration>Financial>Insurance Codes>EMC.
|
|
Test Submission Indicator
|
Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
|
Emdeon Commercial Home Health (HH), 837P 4010A1 Electronic
This format is available for any insurance defined as commercial and using a CMS-1500 claim format. All formatting is done using the default values for CMS-1500 and the use of print variations.
For those commercial claims being sent through Emdeon, all claims will report the detail service lines as follows:
|
>
|
Detail Line Reporting, No Summary.
|
|
>
|
No grouping of any details.
|
|
>
|
Sort details by Item Date, Revenue Code, HCPCS/CPT, Place of Service, and Type of Service.
|
The following fields in the application are required for Emdeon Commercial Home Health (HH), 837P 4010A1 Electronic.
|
Field
|
Description
|
|
Assignment of Benefits
and
Release of Information
|
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.
|
|
Insurance Clearinghouse
|
Add Emdeon as an insurance clearinghouse in Administration>Financial>Ins Clearinghouse.
Select Emdeon in the Clearing House field in Administration>Financial>Insurance Codes>EMC for the insurance code being billed.
|
|
Insurance Type Code
|
Select the appropriate code identifying the type of insurance policy within a specific insurance program in the Insurance Type Code field in Administration>Financial>Insurance Codes>General and/or Administration>Financial>Insurance Companies>Company.
|
|
Medicare Assign
|
Select the value other than A in Patient>General>Payers>Pay Source>HIPAA>Medicare Assign.
|
|
Federal Tax ID
-OR-
Social Security Number
-AND-
Provider Taxonomy Code
|
If your commercial carrier requires reporting an attending physician, enter either the physician's federal tax ID or Social Security Number.
Enter the provider's taxonomy code.
In addition, the values from the State License and UPIN fields are also reported.
These fields are located in Resource>General>Roles.
Note: By default, if the Federal Tax ID field is empty for a physician, it is automatically completed with the default value of 999999999. If your agency receives a rejection from Emdeon (formerly WebMD) or any payer submitted through the clearing house solution for invalid federal tax ID, your agency must obtain the actual federal tax ID from the physician and enter it in the appropriate field.
|
|
Patient Sign (Patient Signature Code)
|
If the Rel Infor (Release of Information) field in Patient>General>Payers>HIPAA is set to Y, select the appropriate patient signature code, if different from the default code of B (Signed authorization form for CMS-1500, Block 12/13 on file).
|
|
Payer Claim Office #
|
If required by your carrier, indicate the claim office number to which the claim will be sent in the Payer Claim Office # field in Administration>Financial>Insurance Companies>Company.
|
|
Payer IDs
|
If the commercial claims are to be filed through the Emdeon, associate each insurance carrier with payer IDs from the Emdeon's payer list in Administration>Financial>Ins Clearinghouse>Payer IDs.
|
|
Program (Special Program Code)
|
In Patient>General>Payers>Pay Source>HIPAA, select the appropriate special program. This field is empty by default for each carrier.
|
|
Provider ID
|
Enter the organization's carrier-assigned provider number in the Provider ID field in Administration>Financial>Insurance Companies>Company.
|
|
Provider ID Type
|
To meet HIPAA requirements, for commercial carriers that are Blue Cross/Blue Shield, specify if the provider ID (entered in the Provider ID field) is Blue Cross or Blue Shield in the Provider ID Type field in Administration>Financial>Insurance Companies>Company.
|
|
Provider Taxonomy Code
|
Depending upon your Insurance Company setup, enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>General or in Administration>Financial>Insurance Companies>Company.
|
|
Receiver ID
|
Enter 133052274 in the Receiver ID field in Administration>Financial>Ins Clearinghouse>General.
|
|
Receiver Name
|
Enter Emdeon in the Receiver Name field in Administration>Financial>Ins Clearinghouse>General.
|
|
Submitter ID
|
Enter the submitter ID assigned by Emdeon in the Submitter ID field in Administration>Financial>Insurance Codes>EMC.
|
|
Test Submission Indicator
|
Ensure the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC is clear because Emdeon requires the files to be sent in production mode.
|
|
Emdeon Provider Site ID
|
Enter the provider site ID assigned by Emdeon identifying the specific agency office to be sent to (one site ID for a tax ID) in the Emdeon Provider Site IDfield in Administration>Configuration>Business Units>Teams and Legal Entities>Legal Entities.
|
Emdeon Commercial Home Health (HH), 837P 5010A1 Electronic
This format is available for insurances using CMS-1500 (02/12) and defined as commercial. All formatting is done using the default values for CMS-1500 (02/12) and print variations.
The commercial claims sent through Emdeon report the detail service lines as follows:
|
>
|
Detail Line Reporting, No Summary.
|
|
>
|
No grouping of any details.
|
|
>
|
Sort details by Item Date, Revenue Code, HCPCS/CPT, Place of Service, and Type of Service.
|
If required by your commercial payer, select one of the following options for reporting the services in Administration>Financial>Insurance Codes>Print Variationsunder the Box 24:
|
>
|
Summarize the charges by type of service on consecutive days – To consolidate services provided on the consecutive dates. For example, if two services were provided on April 1 and April 2, and then other three services on April 4, 5, and 6, the EMC will show 2 service lines.
|
|
>
|
Summarize the charges by type and date of service – To consolidate services provided on the same date.
|
The following fields in the application are required for Emdeon Commercial Home Health (HH), 837P 5010A1 Electronic.
|
Field
|
Description
|
|
Assignment of Benefits
and
Release of Information
|
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. I is also acceptable for ANSI 5010.
|
|
Insurance Clearinghouse
|
Add Emdeon as an insurance clearinghouse in Administration>Financial>Ins Clearinghouse.
Select Emdeon in the Clearing House field in Administration>Financial>Insurance Codes>EMC for the insurance code being billed.
|
|
Insurance Type Code
|
Select the appropriate code identifying the type of insurance policy within a specific insurance program in the Insurance Type Code field in Administration>Financial>Insurance Codes>General and/or Administration>Financial>Insurance Companies>Company.
|
|
Medicare Assign
|
If needed, select the value other than A in Patient>General>Payers>Pay Source>HIPAA>Medicare Assign.
|
|
Federal Tax ID
-OR-
Social Security Number
-AND-
Provider Taxonomy Code
|
If your commercial carrier requires reporting an attending physician, enter either the physician's federal tax ID or Social Security Number.
Enter the provider's taxonomy code.
Enter the NPI.
In addition, the values from the State License and UPIN fields are also reported.
These fields are located in Resource>General>Roles.
Note: By default, if the Federal Tax ID field is empty for a physician, it is automatically completed with the default value of 999999999. If your agency receives a rejection from Emdeon (formerly WebMD) or any payer submitted through the clearing house solution for invalid federal tax ID, your agency must obtain the actual federal tax ID from the physician and enter it in the appropriate field.
|
|
Patient Sign (Patient Signature Code)
|
If the Rel Infor (Release of Information) field in Patient>General>Payers>HIPAA is set to Y, select the appropriate patient signature code, if different from the default code of B (Signed authorization form for CMS-1500, Block 12/13 on file).
|
|
Payer Claim Office #
|
If required by your carrier, indicate the claim office number to which the claim will be sent in the Payer Claim Office # field in Administration>Financial>Insurance Companies>Company.
|
|
Payer IDs
|
If the commercial claims are to be filed through the Emdeon, associate each insurance carrier with the payer IDs from the Emdeon's payer list in Administration>Financial>Ins Clearinghouse>Payer IDs.
|
|
Program (Special Program Code)
|
Select the appropriate special program in Patient>General>Payers>Pay Source>HIPAA. This field is empty by default for each carrier.
|
|
Provider ID
|
Enter the organization's carrier-assigned provider number in the Provider ID field in Administration>Financial>Insurance Companies>Company.
|
|
Provider ID Type
|
To meet HIPAA requirements, for commercial carriers that are Blue Cross/Blue Shield, specify if the provider ID (entered in the Provider ID field) is Blue Cross or Blue Shield in the Provider ID Type field in Administration>Financial>Insurance Companies>Company.
|
|
Provider Taxonomy Code
|
Depending on your insurance company setup, enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>General or in Administration>Financial>Insurance Companies>Company.
|
|
Receiver ID
|
Enter 133052274 in the Receiver ID field in Administration>Financial>Ins Clearinghouse>General.
|
|
Receiver Name
|
Enter EMDEON in the Receiver Name field in Administration>Financial>Ins Clearinghouse>General.
|
|
Submitter ID
|
Enter the submitter ID assigned by Emdeon in the Submitter ID field in Administration>Financial>Insurance Codes>EMC.
|
|
Test Submission Indicator
|
Ensure the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC is clear because Emdeon requires the files to be sent in production mode. The general login to the Emdeon system is used to indicate if production or test files are being sent.
|
Emdeon Commercial Institutional Hospice (HO), UB-04 Hardcopy
Create the hardcopy format by using the standard print variations for UB-04.
For Emdeon Commercial Institutional Hospice (HO), UB-04 Hardcopy, define the following items:
|
>
|
In Administration>Financial>Insurance Codes>Print Variations, select the check box under FL 14-15 to ensure the ANSI 5010 Billing Template compliance.
|
|
>
|
Ensure that Y is selected for ANSI 5010 in the Rel Infor(Release of Information) field in Patient>General>Payers>HIPAA.
|
Emdeon Commercial Hospice (HO), 837I 4010A1 Electronic
The commercial claims sent through Emdeon report the detail service lines as follows:
|
>
|
Detail Line Reporting, No Summary.
|
|
>
|
Group details (visits and supplies) by Item Date, Revenue Code, HCPCS/CPT, and Description.
|
|
>
|
Sort details by Item Date, Revenue Code, HCPCS/CPT, and Description.
|
The following fields in the application are required for Emdeon Commercial Hospice (HO), 837I 4010A1 Electronic.
|
Field
|
Description
|
|
Assignment of Benefits
and
Release of Information
|
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.
|
|
Federal Tax ID
-OR-
Social Security Number
-AND-
Provider Taxonomy Code
|
If your commercial carrier requires reporting an attending physician, enter either the physician's federal tax ID or Social Security Number.
Enter the provider's taxonomy code.
In addition, the values from the State License and UPIN fields are also reported.
These fields are located in Resource>General>Roles.
Note: By default, if the Federal Tax ID field is empty for a physician, it is automatically completed with the default value of 999999999. If your agency receives a rejection from Emdeon (formerly WebMD) or any payer submitted through the clearing house solution for invalid federal tax ID, your agency must obtain the actual federal tax ID from the physician and enter it in the appropriate field.
|
|
Payer Claim Office #
|
If required by your carrier, indicate the claim office number to which the claim will be sent in the Payer Claim Office # field in Administration>Financial>Insurance Companies>Company.
|
|
Payer IDs
|
If the commercial claims are to be filed through Emdeon, associate each insurance carrier with payer IDs from the Emdeon's payer list in Administration>Financial>Ins Clearinghouse>Payer IDs.
|
|
Provider ID
|
Enter the organization's carrier-assigned provider number in the Provider ID field in Administration>Financial>Insurance Companies>Company.
|
|
Provider ID Type
|
To meet HIPAA requirements, for commercial carriers that are Blue Cross/Blue Shield, specify if the provider ID (entered in the Provider ID field) is Blue Crossor Blue Shield in the Provider ID Type field in Administration>Financial>Insurance Companies>Company.
|
|
Provider Taxonomy Code
|
Depending upon your Insurance Company setup, enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>General.
|
|
Receiver ID
|
Enter 133052274 in the Receiver ID field in Administration>Financial>Ins Clearinghouse>General.
|
|
Receiver Name
|
Enter Emdeon in the Receiver Name field in Administration>Financial>Ins Clearinghouse>General.
|
|
Request for Paper EOB
|
To receive a paper EOB, select the Request Paper EOB check box in Administration>Financial>Insurance Codes>EMC.
|
|
Test Submission Indicator
|
Ensure the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC is clear because Emdeon requires the files to be sent in production mode.
|
|
Emdeon Provider Site ID
|
Enter the provider site ID assigned by Emdeon identifying the specific agency office to be sent to (one site ID for a tax ID) in the Emdeon Provider Site ID field in Administration>Configuration>Business Units>Teams and Legal Entities>Legal Entities.
|
Emdeon Commercial Hospice (HO), 837I 5010A2 Electronic
The commercial claims sent through Emdeon report the detail service lines as follows:
|
>
|
Detail Line Reporting, No Summary.
|
|
>
|
Group details (visits and supplies) by Item Date, Revenue Code, HCPCS/CPT, and Description.
|
|
>
|
Sort details by Item Date, Revenue Code, HCPCS/CPT, and Description.
|
If you need to report the external cause of injury diagnoses, enter them using claim constants at the appropriate level for FL 72A–C External Cause of Injury Code.
The following fields in the application are required for Emdeon Commercial Hospice (HO), 837I 5010A2 Electronic.
|
Field
|
Description
|
|
Assignment of Benefits
and
Release of Information
|
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.
|
|
Federal Tax ID
-OR-
Social Security Number
-AND-
Provider Taxonomy Code
-AND-
NPI
|
If your commercial carrier requires reporting an attending physician, enter either the physician's federal tax ID or Social Security Number.
Enter the provider's taxonomy code.
Enter the NPI.
In addition, the values from the State License and UPIN fields are also reported.
These fields are located in Resource>General>Roles.
Note: By default, if the Federal Tax ID field is empty for a physician, it is automatically completed with the default value of 999999999. If your agency receives a rejection from Emdeon (formerly WebMD) or any payer submitted through the clearing house solution for invalid federal tax ID, your agency must obtain the actual federal tax ID from the physician and enter it in the appropriate field.
|
|
Payer Claim Office #
|
If required by your carrier, indicate the claim office number to which the claim will be sent in the Payer Claim Office # field in Administration>Financial>Insurance Companies>Company.
|
|
Payer IDs
|
If the commercial claims are to be filed through Emdeon, associate each insurance carrier with payer IDs from the Emdeon's payer list in Administration>Financial>Ins Clearinghouse>Payer IDs.
|
|
Provider ID
|
Enter the organization's carrier-assigned provider number in the Provider ID field in Administration>Financial>Insurance Companies>Company.
|
|
Provider ID Type
|
To meet HIPAA requirements, for commercial carriers that are Blue Cross/Blue Shield, specify if the provider ID (entered in the Provider ID field) is Blue Crossor Blue Shield in the Provider ID Type field in Administration>Financial>Insurance Companies>Company.
|
|
Provider Taxonomy Code
|
Depending upon your Insurance Company setup, enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>General.
|
|
Receiver ID
|
Enter 133052274 in the Receiver ID field in Administration>Financial>Ins Clearinghouse>General.
|
|
Receiver Name
|
Enter EMDEON in the Receiver Name field in Administration>Financial>Ins Clearinghouse>General.
|
|
Request for Paper EOB
|
To receive a paper EOB, select the Request Paper EOB check box in Administration>Financial>Insurance Codes>EMC.
|
|
Test Submission Indicator
|
Ensure the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC is clear because Emdeon requires the files to be sent in production mode.
|
|
Emdeon Provider Site ID
|
Enter the provider site ID assigned by Emdeon identifying the specific agency office to be sent to (one site ID for a tax ID) in the Emdeon Provider Site ID field in Administration>Configuration>Business Units>Teams and Legal Entities>Legal Entities.
|
Emdeon Commercial Professional Hospice (HO), CMS-1500 (08/05) Hardcopy
Create the hardcopy format by using the standard print variations for CMS-1500 (08/05).
Emdeon Commercial Hospice (HO), 837P 4010A1 Electronic
This format is available for insurances using CMS-1500 and defined as commercial. All formatting is done using the default values for CMS-1500 and print variations.
The commercial claims sent through Emdeon report the detail service lines as follows:
|
>
|
Detail Line Reporting, No Summary.
|
|
>
|
Group details (visits and supplies) by Item Date, Revenue Code, HCPCS/CPT, and Description.
|
|
>
|
Sort details by Item Date, Revenue Code, HCPCS/CPT, and Description.
|
The following fields in the application are required for Emdeon Commercial Hospice (HO), 837P 4010A1 Electronic.
|
Field
|
Description
|
|
Assignment of Benefits
and
Release of Information
|
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.
|
|
Federal Tax ID
-OR-
Social Security Number
-AND-
Provider Taxonomy Code
|
If your commercial carrier requires reporting an attending physician, enter either the physician's federal tax ID or Social Security Number.
Enter the provider's taxonomy code.
In addition, the values from the State License and UPIN fields are also reported.
These fields are located in Resource>General>Roles.
Note: By default, if the Federal Tax ID field is empty for a physician, it is automatically completed with the default value of 999999999. If your agency receives a rejection from Emdeon (formerly WebMD) or any payer submitted through the clearing house solution for invalid federal tax ID, your agency must obtain the actual federal tax ID from the physician and enter it in the appropriate field.
|
|
Insurance Clearinghouse
|
Add Emdeon as an insurance clearinghouse in Administration>Financial>Ins Clearinghouse.
Select Emdeon in the Clearing House field in Administration>Financial>Insurance Codes>EMC for the insurance code being billed.
|
|
Insurance Type Code
|
Select the appropriate code identifying the type of insurance policy within a specific insurance program in the Insurance Type Code field in Administration>Financial>Insurance Codes>General and/or Administration>Financial>Insurance Companies>Company.
|
|
Medicare Assign
|
If needed, select the value other than A in Patient>General>Payers>Pay Source>HIPAA>Medicare Assign.
|
|
Patient Sign (Patient Signature Code)
|
If the Rel Infor (Release of Information) field in Patient>General>Payers>HIPAA is set to Y, select the appropriate patient signature code, if different from the default code of B (Signed authorization form for CMS-1500, Block 12/13 on file).
|
|
Payer Claim Office #
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If required by your carrier, indicate the claim office number to which the claim will be sent in the Payer Claim Office # field in Administration>Financial>Insurance Companies>Company.
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Payer IDs
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If the commercial claims are to be filed through Emdeon, associate each insurance carrier with payer IDs from the Emdeon's payer list in Administration>Financial>Ins Clearinghouse>Payer IDs.
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Place of Service Code
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As required by HIPAA, enter this facility tax ID and State License Number in Resource>General>Roles.
If the Print facility where services rendered print variation has been selected in FL 32, and any of the claim's detail charge lines contain the 21or 31 place of service code, then the facility associated with the first charge line in the claim must be reported.
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Program (Special Program Code)
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Select the appropriate special program in Patient>General>Payers>Pay Source>HIPAA. This field is empty by default for each carrier.
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Provider ID
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Enter the organization's carrier-assigned provider number in the Provider ID field in Administration>Financial>Insurance Companies>Company.
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Provider ID Type
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To meet HIPAA requirements, for commercial carriers that are Blue Cross/Blue Shield, specify if the provider ID (entered in the Provider ID field) is Blue Cross or Blue Shield in the Provider ID Type field in Administration>Financial>Insurance Companies>Company.
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Provider Taxonomy Code
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Depending on your insurance company setup, enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>General.
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Receiver ID
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Enter 133052274 in the Receiver ID field in Administration>Financial>Ins Clearinghouse>General.
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Receiver Name
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Enter Emdeon in the Receiver Name field in Administration>Financial>Ins Clearinghouse>General.
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Test Submission Indicator
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Ensure the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC is clear because Emdeon requires the files to be sent in production mode.
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Emdeon Provider Site ID
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Enter the provider site ID assigned by Emdeon identifying the specific agency office to be sent to (one site ID for a tax ID) in the Emdeon Provider Site ID field in Administration>Configuration>Business Units>Teams and Legal Entities>Legal Entities.
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Emdeon Commercial Hospice (HO), 837P 5010A1 Electronic
This format is available for insurances using CMS-1500 and defined as commercial. All formatting is done using the default values for CMS-1500 and print variations.
The commercial claims sent through Emdeon report the detail service lines as follows:
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>
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Detail Line Reporting, No Summary.
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>
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Group details (visits and supplies) by Item Date, Revenue Code, HCPCS/CPT, and Description.
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>
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Sort details by Item Date, Revenue Code, HCPCS/CPT, and Description.
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The following fields in the application are required for Emdeon Commercial Hospice (HO), 837P 5010A1 Electronic.
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Field
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Description
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Assignment of Benefits
and
Release of Information
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In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.
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Federal Tax ID
-OR-
Social Security Number
-AND-
Provider Taxonomy Code
-AND-
NPI
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If your commercial carrier requires reporting an attending physician, enter either the physician's federal tax ID or Social Security Number.
Enter the provider's taxonomy code.
Enter the physician's NPI.
In addition, the values from the State License and UPIN fields are also reported.
These fields are located in Resource>General>Roles.
Note: By default, if the Federal Tax ID field is empty for a physician, it is automatically completed with the default value of 999999999. If your agency receives a rejection from Emdeon (formerly WebMD) or any payer submitted through the clearing house solution for invalid federal tax ID, your agency must obtain the actual federal tax ID from the physician and enter it in the appropriate field.
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Insurance Clearinghouse
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Add Emdeon as an insurance clearinghouse in Administration>Financial>Ins Clearinghouse.
Select Emdeon in the Clearing House field in Administration>Financial>Insurance Codes>EMC for the insurance code being billed.
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Insurance Type Code
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Select the appropriate code identifying the type of insurance policy within a specific insurance program in the Insurance Type Code field in Administration>Financial>Insurance Codes>General and/or Administration>Financial>Insurance Companies>Company.
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Medicare Assign
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If needed, select the value other than A in Patient>General>Payers>Pay Source>HIPAA>Medicare Assign.
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Patient Sign (Patient Signature Code)
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If the Rel Infor (Release of Information) field in Patient>General>Payers>HIPAA is set to Y, select the appropriate patient signature code, if different from the default code of B (Signed authorization form for CMS-1500, Block 12/13 on file).
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Payer Claim Office #
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If required by your carrier, indicate the claim office number to which the claim will be sent in the Payer Claim Office # field in Administration>Financial>Insurance Companies>Company.
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Payer IDs
|
If the commercial claims are to be filed through Emdeon, associate each insurance carrier with payer IDs from the Emdeon's payer list in Administration>Financial>Ins Clearinghouse>Payer IDs.
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Place of Service Code
|
As required by HIPAA, enter this facility tax ID and State License Number in Resource>General>Roles.
If the Print facility where services rendered print variation has been selected in FL 32, and any of the claim's detail charge lines contain the 21or 31 place of service code, then the facility associated with the first charge line in the claim must be reported.
|
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Program (Special Program Code)
|
Select the appropriate special program in Patient>General>Payers>Pay Source>HIPAA. This field is empty by default for each carrier.
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Provider ID
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Enter the organization's carrier-assigned provider number in the Provider ID field in Administration>Financial>Insurance Companies>Company.
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Provider ID Type
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To meet HIPAA requirements, for commercial carriers that are Blue Cross/Blue Shield, specify whether the provider ID (entered in the Provider IDfield) is Blue Cross or Blue Shield in the Provider ID Type field in Administration>Financial>Insurance Companies>Company.
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Provider Taxonomy Code
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Depending on your insurance company setup, enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>General.
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Receiver ID
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Enter 133052274 in the Receiver ID field in Administration>Financial>Ins Clearinghouse>General.
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Receiver Name
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Enter EMDEON in the Receiver Name field in Administration>Financial>Ins Clearinghouse>General.
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Test Submission Indicator
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Ensure the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC is clear because Emdeon requires the files to be sent in production mode.
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Emdeon Provider Site ID
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Enter the provider site ID assigned by Emdeon identifying the specific agency office to be sent to (one site ID for a tax ID) in the Emdeon Provider Site ID field in Administration>Configuration>Business Units>Teams and Legal Entities>Legal Entities.
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